Posts Tagged ‘FRAX’
Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD). This is good? WRONG !!
High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen. This means that glucose (sugar) molecules are incorporated into the collagen protein chains. This distorts and stiffens the Bone Matrix.
Normally, stiffer is better, Calcium stiffens the bone matrix, which strengthens the bone. But too much of a good thing is bad. Too stiff becomes brittle. Brittle bones break more easily than “stiff enough” bones.
Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics. Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.
We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves. Now we know that high blood sugars in diabetics are bad for bones too.
Take Control of Your Future. If you have diabetes, work with your primary doc to get your blood sugars under control.
Jay Ginther, MD
Friday, the University of Wisconsin “The Bare Bones of Osteoporosis Care” Symposium had a lot of practical information. This included:
John Belizekian, MD summarized the latest research on HyperParathyroidism. While most of what we see is Secondary HyperParathyroidism, long term Secondary can morph into traditional Tertiary, or into a newly defined type of Primary HyperParathyroidism.
Joseph Shaker, MD explored new insights into Secondary Osteoporosis. These are separate medical conditions which cause osteoporosis and must be addressed if we are to succeed in treating the resulting osteoporosis.
Fergus McKiernan discussed the success of Vertebroplasty and Kyphoplasty – if you choose patients with the right Vertebral Fracture problems to operate on.
Dr Belizekian discussed new therapies which avoid the problems of current medications. Odanocatib, Abaloparatide, and Rososumab are all in FDA phase 3 trials and could be available within 5 years. FRAX can now incorporate TBS (Trabecular Bone Score).
I will cover these topics, along with those discussed at NOF, over the next few weeks.
Jay Ginther, MD
DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer. DXA alone is less good at predicting Fracture Risk. But, Fractures are what we want to avoid.
At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy. Vertebral Fracture Assessment (VFA) helps evaluate bone quality. FRAX was specifically designed to predict Fracture Risk. QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.
ISCD will discuss adding TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT. We are constantly pushing toward our goal – Prevent Fractures.
Preventing Fractures is not just DXA. Get a Complete Bone Health Evaluation.
Take Control of your future. Check your bone health.
Jay Ginther, MD
Wrong Question! What you should be managing is Fracture Risk. If you only look at Bone Mineral Density (BMD), you miss the chance to decrease Fracture Risk in the overwhelming majority of people.
85% of the women who Fracture have a DXA score of “osteopenia” or even “normal”. Keeping their bone density at “only osteopenia” does them no favor. So how can you manage Fracture Risk?